Commitments and conundrums: Human rights and the Global Fund Joanne Csete, PhD, MPH Columbia Univ. Mailman School of Public Health July 2010

Treating AIDS is NOT a crime! Tell Iran to free the Alaeis, AIDS physicians wrongfully imprisoned since June 2008 Sign the petition at IranFreetheDocs.org Dr. Kamiar Alaei Dr. Arash Alaei

Acknowledgment For extensive comments and funding: Canadian HIV/AIDS Legal Network (R. Elliott) Open Society Institute (J. Cohen, S. Kowalski)

Objective Examine human rights content and impact of Global Fund’s grant-making processes grants (program content) advocacy. Attention to the dilemma of commitment to both “country-driven” processes and human rights

Selected results CCM as a public-private structure? Representation of people living with HIV “Key affected populations,” including criminalized persons, in CCMs and in proposed programs? Few direct human rights measures in proposals Women’s rights groups: service delivery vs. advocacy Scaling up controversial programs (e.g. methadone) Not retreating on treatment scale-up Funding of interventions/institutions that raise human rights concerns Excellent advocacy efforts on many points

People who use drugs (PUD) PUD represented on few CCMs; even harm reduction organizations often not represented Through 2009, >$180 million in 42 countries, but few programs on strengthening rights of people who use drugs Special non-CCM grants in cases where PUD or drug use issues excluded from CCM (e.g. Thailand, Russia)  What can GF do to improve PUD participation on CCMs?

Criminal laws that impede HIV responses Urgent need for advocacy and action Require CCM to report on how they affect the HIV response and participation of affected populations Depending on analysis (previous point), consider a requirement that proposals include support for legal assistance, training of police or judicial officials, etc. TRP briefing and guidelines

Detention centers for drug “treatment” Involuntary detention of people who use drugs for “re- education and rehabilitation”; forced labor and repression in guise of “treatment”. GF grants support HIV services in these centers M Kazatchkine (Toronto, 2010): “All compulsory drug detention centres should be closed and replaced by drug treatment facilities that work and that conform to ethical standards and human rights norms.”  Urgently need national-level advocacy to close these centers.  GF needs policy to determine whether support for some services in these settings (and prisons) is possible without reinforcing repression. (Linked to time-bound plan to close down?)

100% condom use programs (100% CUP) Part of HIV response in many countries (esp. in Asia) Meant to ensure condoms used in all commercial sex transactions (brothels, nightclubs) Top-down, designed without sex worker participation Documented abuses – mandatory testing, police abuse, public humiliation of “violators” Rights-based alternatives for achieving high condom use.  CCMs should explain human rights protections, whether other alternatives tried.  Advocacy against repression in programs “for” sex workers; advocacy in favor of sex worker-run programs.

Involuntary sterilization of women living with HIV Namibia: documented cases of involuntary sterilization in hospitals receiving GF support Coerced abortions reported in many countries  GF should commission an investigation in Namibia case  Push CCMs to ensure that fund recipients for vertical transmission activities have measures in place to prevent these abuses.

Global Fund response: gender Global Fund Gender Equality Strategy (2008): CCMs must assess and “declare” their gender capacity; should strive for “sex parity” in membership Gender analysis in national strategies Improved gender capacity on TRP Senior-level Gender Advisor in Secretariat  2009: Adoption of similar strategy with respect to “SOGI”: sexual orientation and gender identity  Is something more needed?

GF gender-related strategies Will they be evaluated with an eye toward whether resources flow to programs that strengthen human rights? If necessary, consider CCM requirements (e.g. CCM membership; evidence of effort to include rights interventions – if no capacity is the problem, prove it and address it; if legal services are needed, include them)

Other means to strengthen rights impact Community systems strengthening: GF line of funds to support community-based organizations Dual track financing: Requirement that there be both NGO and government principal recipients of GF grants  Both should be evaluated for their impact on “key affected populations”.

Advocacy by the Global Fund Many positive examples (treatment for all, drug policy reform, incarceration of MSM, HIV status- based travel restrictions) Much more needed, including on – threats to generic medicine producers, – criminal laws impeding HIV response, – rights-based approaches to sex work and HIV, – ending compulsory drug treatment, – human rights protections in testing scale-up, – activists repressed and imprisoned, etc.

Conclusions Hard to reconcile the dilemma: commitment to rights-based programs may mean more requirements for applicants GF has potential to provide ground-breaking leadership on criminalization and marginalization Important and needed advocacy voice Need for UN agency representatives on CCMs (and others) to advocate for human rights-based processes and programs